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Venue: Virtual - Microsoft Teams

GMC / GDC / GPhC / Professional Registration Number

Salutation/Title

First name

Last name

Mobile number

Which region in the UK are you based in?

Panel Member type

Primary employer type

Primary employer name (to find your employer names start to type the name)

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Have you completed Equality and Diversity training in the last 3 years?

Equality and Diversity completion date

Please provide a contact mobile number *

Are you available to attend all day?

If no - please state your availability (for example Morning session 9am to 1pm or Afternoon session 1pm to 5pm)

What is your current training level?

Please provide us with your NHS email address (Please note we will not be able to provide interview documentation without this)

Have you previously taken part in the Verification process for us?

Time slot	2026 Audiovestibular ST3 - Round 2 Remote Self Assessment Verification	Remove booking?
09:00 - 17:00	( Wednesday 4th February 2026 )

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2026 Audiovestibular Medicine ST3 - R2 Remote Self Assessment Verification
04 Feb 2026 09:00 - 17:00